Spontaneous Pneumomediastinum After Severe Vomiting: CT Imaging Pearls, Differential Diagnosis, and Clinical Management
A Radiology Case Review for Emergency Physicians, Radiologists, and Thoracic Specialists Introduction Acute chest pain following severe vomiting is a clinical presentation that requires immediate attention. Although spontaneous pneumomediastinum (SPM) is generally considered a benign and self-limiting condition, it may mimic life-threatening disorders such as esophageal perforation (Boerhaave syndrome), tracheobronchial injury, acute coronary syndrome, or pulmonary embolism. This case involves a 29-year-old man who presented with severe chest pain after repeated episodes of forceful vomiting. Chest radiography demonstrated subtle mediastinal and cervical air, while chest CT confirmed pneumomediastinum with associated cervical emphysema and a small left pneumothorax. Subsequent esophagoscopy and bronchoscopy excluded esophageal and tracheobronchial perforation, supporting the diagnosis of spontaneous pneumomediastinum secondary to the Macklin effect . This review summarizes the pathoph...